Practice 03 · Special needs & ABA advocacy
The coverage exists. Getting it paid is the work.
Texas mandates autism coverage. Carriers still deny, delay, cap hours, and mis-code. We read the plan document, build the appeal, and stay on the file until therapy is authorized.
Then authorized in nine weeks
Plan document read line by line, BCBA documentation realigned, external review filed. 2026.
Back to the first denial
Full authorization at the prescribed hours, not a negotiated fraction of them.
Not handed to you
Internal appeal, external review, TDI complaint — filed alongside you, on your file.
Four steps, in this order
Each one has a deadline attached, and the deadlines run from dates on paper you may not have read yet.
Coverage audit
Your plan document read line by line against the diagnosis and the prescribed hours.
Working with your provider
Coordinating the BCBA’s documentation with what the carrier’s reviewer actually needs.
Appeal & escalation
Internal appeal, external review, TDI complaint — filed with you, not handed to you.
Long horizon
Special-needs trust, ABLE account (a tax-advantaged savings account for disability expenses), guardianship timing, and the life policy that funds it.
The therapy is prescribed. The argument is with the carrier, not with the family.
Record 2026-02 · Family · ABA advocacy
Denied twice. Authorized in nine weeks.
- Problem
- Prescribed ABA hours denied as “not medically necessary,” twice, with the clock running.
- Method
- Plan document read line by line, BCBA documentation realigned, external review filed.
- Result
- Full authorization at prescribed hours, retroactive to the first denial.
Published with written client consent. Historical, and not a promise of comparable results — outcomes vary by plan, diagnosis, documentation and carrier.
If you are holding a denial letter
Appeal deadlines are printed on it.
The letter states its own appeal rights and the window for each one. Send it over and Michael will read it with you.
Send the letter to MichaelStart with a plan review
Three questions, ninety seconds. You will hear back the same business day — from Michael, not a queue.